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FCM Y1 SGUL > DERMATOLOGY > Flashcards

DERMATOLOGY Flashcards

1
Q

chronic dry and very itchy skin?

A

Eczema

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2
Q

management of mild eczema?

A

generous emollients

mild topical steroids considered on inflamed areas (1% hydrocortisone)

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3
Q

management of moderate eczema?

A

generous emollients
moderately potent topical steroids (0.025 betamethasone valerate or 0.05% clobetasone butyrate)
use mild topical steroid in delicate areas
sever itch/urticaria = oral 1 month non-sedating antihistamine trial

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4
Q

management of severe eczema?

A

generous emollients
inflamed skin = potent topical steroids (0.1 betamethasone valerate)
moderate potency topical steroid for delicate areas
severe itch/urticaria = one month trial of antihistamine
sleep disturbance = sedating antihistamine
severe, extensive eczema = oral prednisolone

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5
Q

lesions are erythematous, vesicles, crusting, scaling
sharp margins confined to site of exposure
rapid onset/within ours of exposure
may occur in everyone

A

Irritant contact dermatitis

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6
Q

lesions erythematous, papules, vesicles, erosions, crusts and scaling
initially sharp margins which eventually spread out over time
onset after 12-72hrs of exposure
occurs only in sensitized

A

Allergic Contact dermatitis

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7
Q

management of contact dermatitis

A

best Tx = avoid contact and decontaminate using soap and water
aveeno baths. calamine lotions. cool compress and oral antihistamines
mild to high potency topical steroids

severe reactions = oral prednisolone - can taper over 7-21 days

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8
Q

clustered erythematous papules, papulovesicular
and papulopustules
more common around the mouth but can form around eyes and nose

typically in females 20-45yrs and associated with steroid use

A

peri-oral eczema

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9
Q

management of peri-oral eczema?

A 
mild = topical metronidazole/erythromycin 
severe = Oral ABx e.g. lymecycline/doxycycline

avoid irritants, alcohol and spicy foods and steroids

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10
Q

symmetric coin shaped lesions
vesicles and papules merge to form a plaque
itchy/pruritic

A

nummular/discoid eczema

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11
Q

management of nummular/discoid eczema?

A

adv to moisturize
moderate to potent steroid
sedating antihistamine if sleep disturbance

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12
Q

hyperpigamented plaques on anterior/medial aspects of lower legs
erythema, ulcers and some oedema
ulceration usually above medial malleolus

may have hx of varicose veins, HF, thrombophlebitis, trauma/surgery to limb or above 50yrs

A

venous stasis eczema

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13
Q

how is venous stasis eczema investigated

A

ABPI - <0.9 = arterial disease

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14
Q

management of venous stasis eczema?

A

compression
elevation and walking
topical steroids or ABx if indicated
tx the ulcers accordingly

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15
Q 
fever 
swollen lymph nodes 
extremely painful blistering rash
monomorphic punched-out erosions, 
circular depressed ulcertaed lesions ~ 1-3cm
A

eczema herpitcum

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16
Q

investigations for eczema herpiticum?

A

clincial diagnosis - viral swabs can be taken

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17
Q

management of eczema herpiticum?

A

oral/IV acyclovir 400-800mg 5x day

severe/systemically affected = hospital admission and IV antiviral preferred.

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18
Q

eczematous lesions in sebum rich areas
(usually scalp, under eye, near ears and around nose)
associated otitis externa or blepharitis

A

seborrheic dermatitis

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19
Q

management of seborrheic dermatitis

A

scalp = OTC zin pyrithin = head n shoulders
or OTC tar = Tgel shampoo
+ ketoconazole

face and body
topical ketoconazole
short term topical steroids

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20
Q

isolated red/brown macule/papule with rough yellow-brown scale over it
usually on temples
may be more than one

A

actinic keratosis

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21
Q

management of actinic keratosis

A

sun avoidance/sun cream
cryotherapy/surgical removal
diclofenac gel = solarase
5-fluorouracil cream = 2-3 week course

others include
tretinon (retin A)
acid peels

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22
Q

round lesion on scalp
surrounding alopecia
can form spongy/boggy mass (leronion)

A

tinea capitis

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23
Q

management of tinea capitis?

A

topical ketoconazole and
oral griseofulvin for adults or
oral terbinafine for children

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24
Q

well-defined annular erythematous lesion withpapules and pustules and clearer central area

A

tinea corporis

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25
Q

management of tinea corporis?

A

oral fluconazole

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26
Q

usually asymtpomatic but may itch
found mainly on trunk, neck and arms
patches are a copper/brown in colour and scaly
may become non-scaly and white once resolved

early 20s
durations months/years

A

tinea versicolor

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27
Q

investigations to confirm tinea versicolour diagnosis?

A

woodlamp
microscopy
fungal culture
skin biopsy

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28
Q

management of tinea versicolour

A

selenium sulphide 2.5% lotion/shampoo used daily for 7-10/7

topical miconazole for 14/7

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29
Q

pruritic superficial rash - large scaly, well-demarcated red/brown plaques
mainly around the groin and adjacent skin
gentials spared

hx of wearing tight underwear, living in tropical climate
obese
athletic
male

A

tinea cruris

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30
Q

management of tinea cruris?

A

topical azole = ketoconazole, clotrimazole or miconazole

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31
Q

young adults
herald patch
erythematous, oval scaly patches with a longitudinal distribution often described as ‘fir tree appearance’
may have has a prodromal viral infection

A

pityriasis rosea

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32
Q

management of pityriasis rosea?

A

self-limiting = usually resolves in 6 weeks

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33
Q

what are the 5 main drug eruptions?

A 
morbilliform 
urticarial 
fixed 
hyperpigmentation 
chemo-induced acral erythema
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34
Q

often 7-10 days after exposure
maculopapular rash which become confluent
itchy
usually spares the face

A

morbilliform

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35
Q

management of morbilliform eruption?

A

antihistamines and cooling lotion

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36
Q

hives mins-hrs after intiating medication

A

urticarial eruption

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37
Q

management of urticarial eruption?

A

antihistamines and cooling lotion +/- epinephrine

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38
Q

round. rythematous plaques mins-hrs after medication initiation
any part of body affected but common in glans penis

A

fixed eruption

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39
Q

tingling in the palms. soles and then swelling/erythema after several days

A

chemo-induced acral erythema

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40
Q

well demarcated, read/silver rash that is ring-shaped

appearing on stratus coneum, hair/follicles and on nails.

A

dermatophyte infections

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41
Q

diagnosis of demratophyte infections?

A

KOH microscopy

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42
Q

management of dematophyte infections?

A

clotrimazole, miconazole & terbinafine

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43
Q

Pruritic, purple polyglonal papules
can merge into plaques
usually on the wrist, ankles, shins, mucous membranes and penis
‘ white lines on surface/wickham’s striae’
oral/buccal mucosa - white lacey pattern

often an eruptiosn due to gold, quinine or thiazides

A

lichens planus

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44
Q

management for lichens planus

A

potent topical steroids (oral/IM injection considered)
sedating antihistamine
monitor mucous membranes - benzydamine mouthwash
UV therapy

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45
Q

sharply marginated erythematous papule with silvery white scale
scales loose and easily removed from scatching
papules grow sharply maginated plaques which merge with each other

can happen on scalp, palms/soles, nails, extensor surfaces and lower back and anterior tibial surface

can lead to joint pain/arthritis
usually in teens/childhood or older pts in 50s
family history present

A

psoriasis

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46
Q

management of psoariasis?

A
  1. potent corticosteroid + vitamin D (tacalcitol or calcipotriol) - OD
  2. increase vit D analgoue to BD dose
  3. if no imporvement in 8-12 weeks = increase steroid to BD dose or start coal tar O/BD
  4. short acting diathanol/anthralin
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47
Q

commonly on shins
pain, redness, warmth and swelling
macular
usually associated with systemic upset = fever

can be linked with venous stasis

A

cellulitis

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48
Q

management of mild cellulitis?

A

first line - flucloxacillin - doxycycline in allergy and macrolide as alternative in pregnancy

if traumatic consider tetanus prophylaxis and outpatient wound check in 24-48hrs

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49
Q

management of severe cellulitis?

A

clindamycin, vancomycin
co-amoxiclav or ceftriaxone
moxifloxacin

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50
Q

inflammation of small vessels
itching/burning rash
1-3mm lesions which may coalesce
often on legs

recent initiation of medication?
autoimmune disorder hx

A

vasculitis

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51
Q

management of vasculitis?

A

treat underlying cause if identified

compression stockings and elevation
sedating antihistamine
if systemic involvement = high dose steroid
no systemic involvement = colchicine or dapsone

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52
Q 
bright red/fiery red lesion on skin 
superficial layers affects
painful, raised and well-demarcated plaques 
malaise 
often on face and lower extremities
A

erysipleas

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53
Q

management of erisipleas?

A

supportive care and analgesia
flucloxacillin
if on face co-amoxiclav and admit to hospital

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54
Q

‘golden’ crusted skin lesions typically around the mouth

commonly in children and warmer weather

A

impetigo

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55
Q

management of limited/localized impetigo?

A

hydrogen peroxide 1% cream if not systemically unwell

topical ABx = fusidic acid or topical mupirocin

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56
Q

management of extensive impetigo?

A

oral flucloxacillin
or alt = macrolide

school exclusion till lesions have crusted ove/ 48hrs after Abx initiation

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57
Q

excessive pruritis either in hair or around pubic regions

A

lice

58
Q

management of lice?

A

permethrin cream - apply at night and wash off in the morning

59
Q

widespread pruritis
linear burrows on the sides on fingers, iterdigital webs or on flexor ascpects of wrists
typically in children/young adults

A

scabies

60
Q

management of scabies

A

first line = premethrin 5% cream - apply from neck down at night and wash off 8-12hr later
second line = melathion 0.5%
treat any bacterial superinfections

treat entire household

61
Q

early features include
erythema migrans/’bulls eye rash’
usually painless
headaches, lethargy, fever and arthralgia

later features
CVS - heart block or peri/myocarditis
neuro = facila palsy, meningitis
MSK = joint effusions

A

lyme disease

62
Q

lyme disease investiagtions?

A

ELISA antibodies and western blot

63
Q

management of lyme disease

A
  1. doxyxyline 100mg BC 21/7
  2. Amoxicillin 1g TDS 14-21/7
  3. azithromycin 500mg 17/7

refer for any neuro involvement

64
Q

management of animal bites

A

control bleeding and irrigate thoroughly with germicisal
consider tetanus and rabies prophylaxis
Give prophylactic Abx = co-amoxiclav - Doxycycline +metronidazole if allergic

refer if systemic illness

65
Q

human bites management?

A

co-amoxiclav as abx prophylaxis

doxycycline and metronidazole if allergic

66
Q

management of skin lacerations

A

assessment of the injury
heamolysis - elevation, pressure and tourniquet
analgesia = systemic or local
skin prep = irrigate debride ragged edges
closure = primary, delayed, secondary
dressings = either non-adherent, lubricated or dry
infection prevention if high risk
follow up in 48-96hrs

67
Q

red and painful burn?

A

first degree

68
Q

pale pink, painful and blistered

A

epidermal second degree

69
Q

white patches of non-blanching erythema, reduced sensation

A

dermal second degree

70
Q

white/brown or balck in colour, no blisters, no pain

A

3rd degree

71
Q

burn extending to subcut fat, muscle, nerves, major blood vessels or bone

A

4th degree

72
Q

epidermal second degree initial management

A 
initial first aid/ clear skin 
tetanus immunisations
topical Abx = silver sufadiazine with bulky occlusive dressing 
hydration (oral preferred)
analgesia 
elevate limbs to control oedema
73
Q

dermal second degree initial management

A

cleanse wound
leave blisters intact - sterile + protective
non-adherent dressing and avoid topical creams
review in 24hrs

74
Q

third degree burn management

A

usually surgical repair or grafting

75
Q

fourth degree burn management

A

often requires amputation or extensive reconstructive surgery

76
Q

refer to burns unit when?

A 
dermal 2nd degree 
3rd/4th degree
inhalation injury 
electrical/chemical burn 
paediatric 
chronic illness or mental illness in pt
77
Q

management of needlestick injuries?

A

first aid
discuss with healthcare profressional - consider prophylaxix eg: pep
investigations = virology, LFTs and hCG
documentation

prevention is key emphasis on prophylaxis

78
Q

well-raised, circumscribed irregularly shaped areas of erythema and oedema
affects both dermal and epidermal layers
very pruritic/itchy

A

urticaria

79
Q

management of urticaria?

A
  1. H1/H2 blockers = benydryl, hydroxyzine or ranitidine
  2. steroids = prednisolone
  3. consider epinephrine if any airway compromise is present

continue Tx for 5 day

80
Q

well-demarcated patches of depigmented skin
peipheries affected more
trauma may precipitate new lesions/areas of depigementation

linked to T2DM, Addisons, thyroid disorders, penicious anaemia and alopecia

A

vitiligo

81
Q

management of vitiligo?

A

topical corticosteroids
topical tacrolimus

photo/UV light therapy
sunscreen
camouflage makeup

82
Q

initially manifests as recurrent, painful and inflamed lumps
commonly in the axilla
nodules may rupture to release mucopurulent, malodourous discharge
merging of nodules may for plaques, sinus tracts or ‘rope-like’ scarring
double comedomes = form fistulae

commonly affects adults under 40 and women more
FHx, smoker, obesity, diabetic, PCOS

A

hidradenitis supperativa

83
Q

management of hidradenitis supperativa?

A

acute flares = steroids or flucloxacillin, surgical I&D may be needed
long term = topical clindamycine or oral clindamycin, doxycycline or rifampicin

reinforce good hygiene, loose clothing, smoking cessation and weight loss if obese

84
Q

patches of bilateral macular areas of hyperpigementation with irregular borders
typically on face

use of contraceptive, recently pregnant or lots of sun exposure

A

melasma (chioasma)

85
Q

management of melasma?

A

opaque sunblock/avoid sun exposure
topical hydroquinolone
tretinoin

86
Q

smooth, rounded, mobile and non tender lump
average 3-5cm
commonly on neck, upper chest or arms

A

lipoma

87
Q

management of lipoma

A

watchful waiting

surgical excision if large or symptomatic

88
Q

discrete nodules, usually mobile often with punctum
common on head, neck and trunk
if inflamed = eythematous and can rupture to release foul-smelling discharge

A

epithelial inclusion/sebaceous cyst

89
Q

management of epithelial inclusion/sebaceous cyst

A

abx if inflamed

surgical excision = entire cyst wall/capsule to prevent recurrence

90
Q

persistently red, broken skin often extending to underlying surfaces
usually over bony prominence

history of lack of mobility

A

decubitus ulcers/pressure sores

91
Q

management of decubitus ulcers/pressure sores

A

reposition and pressure support products
wound management dressings - hydrocolloid dressings
pan relief
Abx if appears infected

92
Q

dark, thick, velvety skin in body folds/creases
often in axilla, neck or groin
skin looks dirty

Hx of T2DM, GI tumours, endocrine disorder or obesity

A

acanthosis nigricans

93
Q

management of acanthosis nigricans

A

treat underlying cause
GI tumour = surgical exclusion

ammonium lactate - 12% PRN to soften skin
aqua glycolic acid BD

94
Q

more common in elderly patients
itchy, tense blsiters around flexures
erythematous, papular or urticarial bullae in inflammatory plaques
no mucosal involvement - doesn’t spread to mouth

A

bullous pemphigoid

95
Q

diagnosis/Ix for bullous pemphigoid

A

Immunofluorescence - IgG and C3 at dermo epidermal junction

96
Q

management of bullous pemphigoid

A

topical or systemic steroids = oral mainly
+/- immunosuppressants

sometime Abx used

97
Q 
target lesion/iris lesions 
vesicles/bullae form in the centre
initially seen on the back of hands or feet before spreading to the torso
upper limbs more common 
mild pruritis

recent infection, or intiation of drug

A

erythema multiforme

98
Q

management of eythema multiforme

A

treat underlying cause

antihistamine, paracetamol, cool compress and steroids

99
Q 
seen in older people 
males>females 
FHx 
stuck to the skin appearance 
brownish papule, grasy/spongy appearance 
commonly on sun exposed areas - back 
keratotic plugs on the surface
A

seborrheic kertoses/ senile keratosis

100
Q

management of seborrheic keratoses

A

have low threshold for melanoma = bisopsy if suspicious

cryotherpay
curettage
routine exams to watch for melanoma

101
Q

found on sun-exposed sites mainly the head and neck
initially pearly, flesh-coloured papule
telangiectasia
may later ulcerate forming a crater and crusting
colour red-pink with a pearly translucent border

A

basal cell carcinoma

102
Q

investigation and diagnosis for BCC

A

biopsy

103
Q

management for BCC?

A

surgical removal, curettage , cyoptherapy
moh’s surgery and radiation therapy

patient ed = avoid sun exposure and self exam

104
Q

slowly evolving isolated keratotic papule or plaque

if highly differentiated = kertainised surface, firm on palpation
if poorly differentiated = no keratinisation, fleshy, granulomatous and soft on palpation

more common in fair skinned blondes and red-heads
may be immunosupressed, smoker, longstanding ulcers, sunlight exposure

A

squamous cell carcinoma

105
Q

investigation for SCC?

A

biopsy

106
Q

management for SCC

A

excision, mohs surgery or radiation therpay

107
Q

a ‘growing mole’
evolving, enlarging or has become elevated
mean diamete 8-12mm
more common in caucasians

family hx or fair skin and chronic sun exposure

A

melanoma

108
Q

investigation for melanoma

A

biopsy

109
Q

management for melanoma

A

2wwr
total excision with margins
stage 1-2 = interferon a
chemo/immunotherapy for metastatic disease

110
Q

smaller blisters on the palms & soles - vesicular eruptions and pruritic
can have a burning sensation

rupture of blister leaves behind dry cracked skin
precipitated by humidity and high temps

A

dyshidrosis/pompholyx

111
Q

management of dyshidrosis/pompholyx

A

topical steroids

emollients
cool compress
burrow’s solution - 10% aluminum acetate dilution

112
Q

well-demarcated, round, oval or linear plaques of confluent papules
thickened skin
accented skin markings
dull red-dark brown/black

usually due to repetitive rubbing/scatching/itching

A

lichen simplex chronicus

113
Q

management of lichen simplex chronicus

A

must stop itching/scratching
occlusive dressing nocte
topical steroids
sedating antihistamines

114
Q

fever malaise
headaches
widespread rash

may have a infection or initiated a drug

A

exanthems

115
Q

management of exanthems

A

treat underlying cause/infection

116
Q

acute, unilateral painful blistering rash - can be erythematous and doesn’t cross the midline

initial prodromal feature include a burning pain over the affected dermatome, fever lethargy and headache

commonly in T1-L2

A

shingles

117
Q

management of shingles

A

NSAIDS/paracetamol - or amitriptyline

if within 72hrs = aciclovir

118
Q

small fleshy warts on the genitals or rectum

may itch or bleed

A

genital warts or condyloma acuminata

119
Q

management of genital warts

A

topical podophyllum or cryotherapy

imiquimod topical cream
trichloroacetic acid
electrocautery laser

120
Q

pinkish or pearly white papules with a central umbilication
usually appear in clusters on the trunk or in flexors
anogenital lesions can occur

A

molluscum contagiosum

121
Q

management of molluscum contagiosum

A

treatment not recommended unless troublesome or unsightly

simple trauma, cryotherapy

122
Q

small rough raised or flattened lumps occur ocer the pressure of areas of the feet

A

verrucae/plantar warts

123
Q

management of verrucae

A

salicylic acid - apply daily for 3/12

freezingtx/cryotherapy

124
Q

maculopapular rash with target lesions which may develop into vesicles or bullae
mucosal involvement
fever and arthralgia

recently started a new medication

A

stevens-johnsons syndorme

125
Q

systemically unwell - pyrexia and tachycardia
scalded appearance over an extensive area
+nikolsky’s sign = epidermis seperated with mild lateral pressure

A

toxic epidermal necrolysis

126
Q

management of toxic epidermal necrolysis

A

stop the precipitating factor
supportive care

IVIG first line
immunosuppressive agents and plasmapheresis

127
Q

presence of whiteheads or blackheads
papules or pustules
modules or cysts
usually in teens/young adults

A

acne vulgaris

128
Q

management of acne

A
  1. good skin hygiene and a single topical agent - retinoid, benzoyl peroxide or steroid, then try combine two single agents
  2. oral abx on a daily basis or oral COC
  3. oral isotretinoin (roacutane)
129
Q

typically affecting the nose, mouth and forehead
flushing/heat on face
telengiestasia
persistent erythema - sometimes with pustules and papules

maybe associated with conjunctivitis, stye.chalazions and blepharitis
rhinophyma

usually 30-50s and more common in females

A

rosacea

130
Q

management of rosacea

A
  1. daily topical metronidazole
  2. oral Abx = tetracyclines
    last resort = isotretinoin or private laser tx

reduce exposure to alcohol and hot beverages
pt with rhinophyma - refer

131
Q

itchy, erythematous pustules - often clustered and by hair follicles

A

folliculitis

132
Q

management of folliculitis

A

topical aseptic wash = chlorhexidine
oral Abx = flucloxacillin for s.aureus
ciprofloxacin for pseudomonas

133
Q

eythematous painful swollen lateral or proximal nail fold

might have purulent/abscess

A

paronychia

134
Q

management of paronychia

A

warm socks
flucloxacillin
consider I&D

135
Q

bitemporal recession of hair often spared at the occiput and a thin band around the sides
horse-shoe shape
in males mainly

in females = loss of oestrogen = thinning

A

androgenic alopecia

136
Q

management of androgenic alopecia

A

minoxidil (2% or 5% in males)

finesteride in males only

137
Q

yellow white nail separates from nailbed

A

distal or lateral subungual

138
Q

nail soft dry powdery and adherent to bed and not thick

A

superficial white

139
Q

nail surface intact

debris causes nail to seperate

A

proximal subungual

140
Q

thick nail plate

yellow/brown colour

A

candida nail infection

FCM Y1 SGUL (15 decks)

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